MAYA FE NG-DARJUAN, MD-RN
◦Neoplastic disorder that can
involve all body organs
◦Cells lose their normal
growth-controlling
mechanism
◦Growth of cells uncontrolled
via Contact inhibition and Suppresor gene
MAYA FE NG-DARJUAN MDRN
CELL CYCLE
2-5 hrs
6-8 hrs
8hrs or more
Go – Resting phase
Restriction checkpoint
Source: Core Curriculum for Oncology
Nursing (Itano and Taoka)
MAYA FE NG-DARJUAN MDRN
PARTS OF A CELL
Acquired
(environmental DNA
damaging agents)
Chemicals
Radiation
viruses
CARCINOGENESIS
Normal Cell
Successful DNA repair
DNA Damage
Failure of DNA repair
Mutations in the genome of
somatic cells
Activation of growth
promoting oncogene
Alteration of genes that regulates
apoptosis
Inactivation of cancer
suppresssor genes
Expression of altered gene
products
Loss of regulatory gene product
•Clonal expansion
•Additional mutations
•Heterogeneity
MALIGNANT NEOPLASM
Source: Core Curriculum for Oncology
Nursing (Itano and Taoka)
MAYA FE NG-DARJUAN MDRN
 Clinical
Staging
◦ 0: cancer in situ
◦ 1: tumor limited to tissue of origin
◦ 2: limited local spread
◦ 3: extensive local and regional spread
◦ 4: metastasis
 TNM
Classification
◦Tumor size
◦Spread to lymph nodes
◦Metastasis
 Reduce
or avoid exposure to
known or suspected carcinogens
 Eat balanced diet
 Exercise regularly
 Adequate rest
 Health examination on a regular
basis
 Eliminate,
reduce, or change perceptions
of stressors and enhance ability to cope
 Enjoy consistent periods of relaxation
and leisure
 Know 7 warning signs of cancer
 Self-examination
 Seek medical care if cancer is suspected
 Patient
may experience fear and
anxiety
 Clear and repeated explanations may
be necessary
 Diagnostic plan includes
◦ Health history (emphasis on risk factors)
◦ Physical exam
◦ Specific studies
 Biopsy
- involves histologic
examination by a pathologist of a
piece of tissue
 Imaging techniques – CT scan,
MRI, UTZ
 Laboratory test and tumor
markers.
 SURGERY
 CHEMOTHERAPY
 RADIOTHERAPY
 IMMUNOMODULATION
 BONE
MARROW TRANSPLANT
 Goal
is to reduce number of
cancer cells in the tumor site(s)
◦ Directed to cells with high mitotic
index
Main problem:
◦ Cancer cells can escape death by
staying in the G0 phase
◦ drug- resistant
 Cell-cycle
Nonspecific (CCNS)
◦ Alkylating agents - CYCLOPHOSPHAMIDE
◦ Antitumor antibiotics - DOXORUBICIN
◦ Hormones - CORTICOSTEROIDS
 Cell
specific (CCS)
◦ Antimetabolites – FLOUROURACIL
◦ Mitotic inhibitors – VINCA ALKALOIDS
 Oral
 IM
 IV
 Intracavitary
 Intrathecal
 Intraarterial
 Continuous
infusion
 Subcutaneous
 Topical
•
causing cross- linking of DNA
strands
• Cell cycle-nonspecific (CCNS)
ALKYLATING AGENTS
1. Busulfan (myleran)
2. Carboplatin (Paraplatin)
3. Carnustine ( BCNU)
4. Chlorambucil ( Leukeran)
5. Cisplatin ( Platinol AQ)
6. Cyclophosphamide ( Cytoxan)
7. Ifosfamide ( (Ifex)
8. Lomustine ( CCNU)
9. Melphalan ( Alkeran)
10. Streptozocin ( Zanosar)
11. Temozolamide ( Temodar)
acts like a
natural
metabolite
thus disrupting
cancer
metabolic
processes
• CCS – S phase
•
ANTIMETABOLITES
1.
2.
3.
4.
5.
Capecitabine ( Xeloda)
Cladribine ( Leustatin)
Clofarabine ( Clolar)
Cytarabine Hcl ( Cytosar)
Fludarabine ( Fludara)
6. Fluorouracil ( 5-FU)
7. Gemcitabine ( gemzar)
8. Mercaptopurine ( 6-MP, Purinethol)
9. Methotrexate ( MTX)
10. Thiohuanine ( TG, Tabloid)
•
SIDE EFFECTS
• same as alkylating agents
•
•
•
•
Bone marrow depression
• Infection
• Bleeding
• anemia
GI disturbance
hemorrhagic cystitis
Skin – stomatitis, alopecia
PERIWINKLE
PLANT
MOA:
• Block the formation of the
mitotic spindle during mitosis,
thus inhibiting cell division
• Cell cycle specific agents
PERIWINKLE
PLANT

NATURAL PRODUCTS

1. Etoposide ( Ve Pesid)

2. Docetaxel ( Taxoterel)

3. Paclitaxel ( Taxol)

4. Vinblastine sulfate ( Velban)

5. Vincristine sulfate ( Oncovir)

6. Vinorelbine ( Navelbine)
MOA:
• Bind to DNA, inhibiting DNA
or RNA synthesis, eventually
inhibits protein synthesis,
preventing cell replication
•
CCNS
ANTIBIOTICS
1.
2.
3.
4.
5.
6.
7.
Daunorubicin ( Cerubidine)
Doxorubicin ( Adriamycin)
Epirubicin ( Ellence)
Idarubicin ( Idamycin)
Mitomycin C ( Mutamycin)
Mitoxantrone ( Novantrone)
Valrubin ( valstar)
Note:
Doxurubicin is cardiotoxic
1.
2.
CORTICOSTEROIDS – antiinflammatory
HORMONE
a. ESTROGEN – retards prostate cancer
b. PROGESTINS – retards breast and
uterine cancer
c. TAMOXIFEN – synthetic anti-estrogen,
DRUG
INDICATIONS
1. AMIFOSTINE(
Ethyol)
Reduce cumulative toxicity associated
with repeated administration of
CISPLATIN in patients with advanced
ovarian cancer
2. DEXRAZOXANE
( Zinecard)
Reduce the incidence and severity of
cardiomyopathy associated with
DOXORUBICIN in women with
metastatic breast cancer.
3. MESNA( Mesnex) Reduce the incidence of IFOSFAMIDE
and CYCLOPHOSPHAMIDE induced
hemorrhagic cystitis
 Chemotherapeutic
agents cannot
distinguish between normal and
cancer cells
 Body’s
response to products of
cellular destruction in circulation
may cause fatigue, anorexia, and
taste alterations
 Acute
toxicity
◦ Vomiting
◦ Allergic reactions
◦ Arrhythmias
 Delayed
effects
◦ Mucositis
◦ Alopecia
◦ Bone marrow suppression
 Chronic
toxicities
◦ Damage to
 Heart
 Kidney
 Liver
 Lungs
•
SIDE EFFECTS:
• Bone marrow depression
• Infection
• Bleeding
• anemia
• GI disturbance
• hemorrhagic cystitis
• Skin – stomatitis, alopecia
•
CLIENT TEACHINGS
• Take drug in the day –
prevent drug accumulation at
night
• Excreted in breast milk
• Reversible oligospermia –
sperm bank
•
CLIENT TEACHINGS
• Avoid pregnancy for 3-4 mos
• Protective isolation
• Good oral hygiene – soft bristled
toothbrush
• Recommend wig, head scarf
• Low purine diet – organ meats, beans
and peas
- alkalinize the urine
• Small frequent meals
 Drugs
usually given in combination
◦ synergistic efffects
◦ CCNS and CCS combination
◦ note: combined side effects also
 Carefully
calculated according to body
weight or body surface area
 Must
differentiate between
tolerable side effects and toxic
side effects
 Serious
reactions must be
reported
◦ Some toxicities are not reversible
 Administration
drugs
of antiemetic
 Monitor
lab results, particularly
WBCs, platelet, and RBCs
◦ Assess for signs of bleeding if
platelet count falls below 50,000/μl
 Patient
must be told what to
expect to decrease anxiety
 Encourage discussion of fears
 Reassure patient that situation
is only temporary
 Inform patient of supportive
care that will be provided
 Risk
for leukemias and other
secondary malignancies resulting
from therapy
 Secondary
reported
malignancies have been
◦ Includes breast, ovarian, uterine, thyroid,
and lung cancers, fibrosarcomas
1.
A client is scheduled to receive doxorubicin
(Adriamycin) as part of his treatment for
cancer. You note in his medical record that
he is taking a calcium channel blocker (e.g.,
verapamil). As the nurse you will monitor
closely the client because:
A. doxorubicin decreases the
effectiveness of verapamil.
B. doxorubicin increases the toxicity of
verapamil.
C. calcium channel blockers increase the risk
of cardiac toxicity.
D. calcium channel blockers decrease the risk
of cardiac toxicity.
Answer: C
Your client is scheduled to receive fluorouracil
(5-FU) to treat colon cancer. Which of the
following statements made by your client
indicates a need for additional teaching about
5-FU?
A. “I should call the physician if I develop
signs of infection.”
B. “I should examine my mouth occasionally
for soreness or ulceration.”
C. “I should not visit anyone who has the flu
or a cold.”
D. “I should use sunscreen when I go
outside during the daylight.”
Answer: B